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General NPI Number Information
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NPI Number | 1275793028
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Entity Type | Organization
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Legal Business Name | BUCKEYE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 06/16/2008
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 4888 ARMANDALE AVE NW
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City | CANTON
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State | OH
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Zip | 44718-2284
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Country | US
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Telephone | 330-829-9389
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Fax | 330-829-9372
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Provider Business Mailing Address
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Address Line | PO BOX 2779
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City | ALLIANCE
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State | OH
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Zip | 44601-0779
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Country | US
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Telephone | 330-829-9389
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Fax | 330-829-9372
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Authorized Official
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Title or Position | PSYCHIATRY
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Name | RANGA R THALLURI
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Credential | MD
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Telephone | 330-829-9389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35062816
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License Number State | OH
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